Skin Prick Test Sensitivity Research Articles

The Danger of Disappearing Allergen Skin Test Substances

Allergic diseases affect approximately one-quarter to one-half of the average population under 50 years of age in Central Europe. Due to the high proportion of affected individuals, allergy testing needs to be performed on a large scale, with high sensitivity and specificity at a low cost. Skin tests are the most important diagnostic measure fulfilling these requirements: they can be performed immediately and, quite in contrast to laboratory tests, the results of skin prick tests for the diagnosis of immediate allergy (IgE-mediated: Type I) can be assessed, and discussed with the patients 15–20 minutes later. Patients do not need to be called in for a second appointment to discuss the results of serum-based determination of specific IgE. Recently, we demonstrated that the sensitivity of skin prick tests is superior to the measurement of allergen-specific IgE, even for modern molecular allergens. In T cell mediated allergy of the delayed type (contact dermatitis: Type IV), patch tests read after 48–72 hours are the only available diagnostic measure.

Birth order, sibship size, and risk of atopic dermatitis, food allergy, and atopy: A systematic review and meta‐analysis

AbstractBackgroundAtopic dermatitis and food allergy are two frequently concomitant manifestations of the presence of atopy. A substantial number of studies have been published on the association of birth order and sibship size (number of siblings) with atopic dermatitis, food allergy, and atopy. The present work is the first systematic synthesis of the existing literature on this topic.MethodsFifteen databases were searched. Screening, data extraction, and quality assessment were performed by independent pairs. Comparable numerical data were statistically synthesized using random‐effects robust variance estimation.ResultsIn total, 114 studies were included out of 8819 papers obtained from database searches. Birth order ≥2 versus 1 was associated with lower risk of ever atopic dermatitis (pooled risk ratio [RR] 0.91, 95% CI 0.84–0.98), current food allergy (RR 0.77, 95% CI 0.66–0.90), and positive skin prick test (SPT) to common aeroallergens (RR 0.86, 95% CI 0.77–0.97). Sibship size ≥2 versus 1 was associated with decreased risk of current atopic dermatitis (RR 0.90, 95% CI 0.83–0.98), ever atopic dermatitis (RR 0.92, 95% CI 0.86–0.97), and positive SPT to common aeroallergens (RR 0.88, 95% CI 0.83–0.92). No putative associations were seen regarding atopy assessed through allergen‐specific immunoglobulin E with common allergens.ConclusionThe presence of siblings and being second‐born or later may decrease the lifetime risk of atopic dermatitis and food allergy, albeit marginally. Similar association was seen with SPT sensitization. However, significant protection was not found for IgE sensitization.

Comparative characteristics of methods of allergological examination for house dust mite allergy in children with bronchial asthma and allergic rhinitis

Objective. To determine the diagnostic significance of methods of allergological diagnostics: skin prick tests (SPT), quantitative determination of specific immunoglobulin E (sIgE) and nasal provocative test (NPT) in children with allergy to house dust mites (HDM) diagnosed with allergic rhinitis (AR) or AR in combination with asthma. 
 Methods. Patients underwent a targeted history taking for possible domestic sensitization, SPT with HDM allergens, NPT with HDM, and sIgE to HDM allergens was determined by the ImmunoCAP method. 
 Results. The statistical processing group included 109 children (67 boys, 42 girls, aged 5 to 17,9 years (mean age 8,9±2,52 years)), in whom sensitization to HDM was confirmed by at least one of the methods used in the study. A higher sensitivity of SPT then of sIgE was determined (96,3% and 81,6%, respectively). According to SPT and sIgE results, sensitization to both types of mites (D. pteronyssinus and D. farinae) is more common than isolated. Coincidence of positive results of SPT and sIgE was obtained in 84 cases (77,1%). 
 Conclusion. SPT can be considered as the first line of investigation. The use of a complex of examination methods is necessary to determine the role of sensitization to HDM, if NPT is taken as the «gold» standard of diagnosis.

Relevance of skin prick test, serum total immunoglobulin E, and absolute eosinophil counts in asthma patients

BACKGROUND: Asthma is a multifaceted condition defined by chronic airway inflammation. Skin prick test (SPT), serum total immunoglobulin E (tIgE), and absolute eosinophil counts (AEC) estimation are commonly available tools for evaluating allergen sensitization. OBJECTIVE: The present study evaluates the sensitivity to common aeroallergens and also compares serum tIgE and AEC levels with spirometry in Indian individuals with a history of allergy symptoms. MATERIALS AND METHODS: An observational prospective study was conducted in the Outpatient Department of Viswanathan Chest Hospital, VPCI, Delhi, between 2017 and 2019. Two hundred asthma patients diagnosed as per the Global Initiative for Asthma guidelines undergo SPT against a battery of common aeroallergens and measured serum tIgE and AEC. RESULTS: Out of 200 cases, the overall prevalence of common aeroallergens sensitization was found to be 57% (114) in asthmatic patients (atopic). SPT positivity to common aeroallergens was highest in people between the ages of 21 and 30 and lowest in people over 50. The most prevalent annoying aeroallergens were found to be weed pollens (14%), house dust mites (11%), fungi (10.5%), tree pollen (9.5%), dust (6%), kapok cotton (5.5%), grass pollen (3.5%), silk (1.5%), and wool (1%). The mean tIgE was higher in atopic asthmatic patients than in nonatopic asthmatic patients (553.25 ± 218.12 IU/ml and 489.1 ± 251.16 IU/ml; P = 0.056). CONCLUSION: In the present study, we found that insects are the most common offending aeroallergens with higher SPT sensitivity and serum tIgE in atopic patients. Spirometry severity is not affected by allergens sensitivity in asthma patients.

Intradermal Testing Doubles Identification of Allergy among 110 Immunotherapy-Responsive Patients with Eustachian Tube Dysfunction

The purpose of this study was to determine whether the sensitivity advantage of intradermal dilutional testing (IDT) is clinically relevant in patients with obstructive Eustachian tube dysfunction (ETD) or otitis media with effusion (OME). This retrospective, private-practice cohort study compared the sensitivity of skin prick tests (SPT) vs. IDT in 110 adults and children with suspected allergy and OME. Primary outcome measure was symptom resolution from allergy immunotherapy (AIT). IDT identified 57% more patients as being allergic, and 8.6 times more reactive allergens than would have been diagnosed using only SPT. Patients diagnosed by IDT had the same degree of symptom improvement from immunotherapy, independent of allergen sensitivity (66% by SPT vs. 63% by IDT; p = 0.69, not different). Low-sensitivity allergy tests, which may fail to identify allergy in over two thirds of children aged 3 to 15 as being atopic, or among 60% of patients with ETD, may explain why many physicians do not consider allergy as a treatable etiology for their patient’s OME/ETD. IDT offers superior sensitivity over SPT for detecting allergens clinically relevant to treating OME/ETD. These data strongly support increased utilization of intradermal testing and invite additional clinical outcome studies.

Comparison of Sensitivities of Skin Prick and Intradermal Tests with Oral Rechallenge Test: A Prospective Interventional Hospital-Based Study.

Background:Identification of culprit drug causing adverse cutaneous drug reactions may not be possible clinically due to the intake of more than one drug.Aim:To compare the sensitivity of skin tests with gold standard oral rechallenge test to detect adverse cutaneous drug reactions.Materials and Methods:This is a prospective interventional hospital-based study of patients with adverse cutaneous drug reactions attending the outpatient department of dermatology and venereology at a tertiary care center over a 12-month period. Skin prick tests, intradermal tests, and oral rechallenge tests were performed in these patients and their sensitivities were compared. The data of quantitative nature is presented in mean and standard deviation, and categorical variables are presented in number and percentage. The sensitivity of skin tests is compared with the gold standard oral rechallenge test.Results:A total of 49 patients with adverse cutaneous drug reactions were evaluated. Clinical spectrum of adverse cutaneous drug reactions ranged from mild to severe, with fixed drug eruption being the commonest (55.1%) followed by maculopapular exanthem (32.7%). The highest incidence was with fluoroquinolones (43.8%) followed by nonsteroidal anti-inflammatory drugs. Fluoroquinolones were the major cause of fixed drug eruption followed by nonsteroidal anti-inflammatory drugs. The sensitivity of skin prick test and intradermal tests were 49% and 73%, respectively and the difference was highly significant (P < 0.001). The difference in sensitivity in skin prick test versus oral rechallenge test and intradermal test versus oral rechallenge test was also highly significant (P < 0.001).Limitations:Small sample size was a major limitation. Histopathological examinations and human leukocyte antigen associations could not be done.Conclusion:Predominant causative drugs were fluoroquinolones followed by nonsteroidal anti-inflammatory drugs. Sensitivities of skin prick test and intradermal test were quite good and these skin tests should be performed before oral rechallenge test in cases of adverse cutaneous drug reactions.

Pattern of allergic sensitization in chronic rhinitis: A 19-year retrospective study.

The pattern of allergic sensitization provides data for physicians to take appropriate care of allergic patients. To analyze the long-term pattern of allergen skin prick test (SPT) sensitization at a single tertiary care hospital in Thailand. Medical records of adult rhinitis patients during 1998 to 2017 were reviewed. Inclusion criteria were chronic rhinitis with positive SPT to at least one aeroallergen in the test panel. Outcome measures were SPT results, clinical symptoms, and their effect on patient quality of life (QoL). Descriptive statistics were used to demonstrate the pattern of sensitization. Multivariate linear regression was used to identify association between evaluated factors and patient QoL. Six thousand five hundred and seventeen adult patients were included in this study. Mean age was 36.4 & 13.8 years. A majority of patients (59.4%) had positive SPT, and 83.7% of those had polysensitization. Dermatophagoides pteronyssinus and sedge were the most common indoor (54.8%) and outdoor allergens (37.7%), respectively. Compared among the various periods of data collection over a 19-year period, there was no major change in the pattern of sensitization. Considering the most recent data from 2013-2017, the prevalence of sensitization increased from 66.8% to 73.7% (p < 0.001). Clinical symptoms, except sneezing and allergen sensitization, affect QoL of chronic rhinitis patients (p < 0.001). House dust mite and sedge are the most common indoor and outdoor allergens. There was no major change in the pattern of sensitization. Almost all allergic symptoms significantly affect QoL.

Does the principle of homologous groups allow a reduction of allergens in the skin prick test panel?

Regulatory and economic conditions drive the application of the concept of homologous groups on therapeutic and diagnostic formulations. In this context, a possible reduction of allergens in the skin prick test panel in the clinical routine should be investigated for the grass, birch and Dermatophagoides homologous group. Grass and cultivated rye skin prick test results of 1101 patients, birch/hazel/alder skin prick test results of 1131 patients and 1068 Dermatophagoides pteronyssinus and farinae skin prick tests were retrospectively evaluated with regard to sensitivity and false-negative rate detecting sensitization against cultivated rye with grass skin prick test, sensitization against hazel and/or alder with birch skin prick test and sensitization towards Dermatophagoides farinae with Dermatophagoides pteronyssinus skin prick test. Skin prick test results in all groups highly correlated in Spearman Rank Order correlation. Sensitivity of grass skin prick test detecting sensitization against cultivated rye was highest with 98.9%, sensitivity of birch skin prick test detecting sensitization toward hazel and alder was 95.6 and 90.0%, respectively. Sensitivity of skin prick test with Dermatophagoides pteronyssinus detecting sensitization towards Dermatophagoides farinae was 93.6%. Only 26 patients with positive rye, hazel, alder or Dermatophagoides farinae skin prick test that were overlooked by grass, birch or Dermatophagoides pteronyssinus skin prick test reported allergic symptoms. In routine clinical practice, sensitization against cultivated rye can safely be detected by skin prick test with grass allergen. In addition, the sensitivity of birch skin prick test is high in terms of sensitization towards hazel, but lower for alder. Sensitivity of Dermatophagoides pteronyssinus skin prick test also is high to detect sensitization towards Dermatophagoides farinae. Further research will indicate if several skin prick test allergens will disappear and be completely replaced by a single skin prick test based on the principle of homologous groups.

Determining Levers of Cost-effectiveness for Screening Infants at High Risk for Peanut Sensitization Before Early Peanut Introduction

Early peanut introduction reduces the risk of developing peanut allergy, especially in high-risk infants. Current US recommendations endorse screening but are not cost-effective relative to other international strategies. To identify scenarios in which current early peanut introduction guidelines would be cost-effective. This simulation/cohort economic evaluation used microsimulations and cohort analyses in a Markov model to evaluate the cost-effectiveness of early peanut introduction with and without peanut skin prick test (SPT) screening in high-risk infants during an 80-year horizon from a societal perspective. Data were analyzed from April to May 2019. High-risk infants with early-onset eczema and/or egg allergy underwent early peanut introduction with and without peanut SPT screening (100 000 infants per treatment strategy) using a dichotomous 8-mm SPT cutoff value (stipulated in the current US guideline). Cost, quality-adjusted life-years (QALYs), net monetary benefit, peanut allergic reactions, severe allergic reactions, and deaths due to peanut allergy. In the simulated cohort of 200 000 infants and using the base case during the model horizon, a no-screening approach had lower mean (SD) costs ($13 449 [$38 163] vs $15 279 [$38 995]) and higher mean (SD) gain in QALYs (29.25 [3.28] vs 29.23 [3.30]) vs screening but resulted in more allergic reactions (mean [SD], 1.07 [3.15] vs 1.01 [3.02]), severe allergic reactions (mean [SD], 0.53 [1.66] vs 0.52 [1.62]), and anaphylaxis involving cardiorespiratory compromise (mean [SD], 0.50 [1.59] vs 0.49 [1.47]) per individual. In deterministic SPT sensitivity analyses at base-case sensitivity and specificity rates, screening could be cost-effective at a high disutility rate (the negative effect of a food allergic reaction) (76-148 days of life traded) for an at-home vs in-clinic reaction in combination with high baseline peanut allergy prevalence among infants at high risk for peanut allergy and not yet exposed to peanuts. If an equivalent rate and disutility of accidental and index anaphylaxis was assumed and the 8-mm SPT cutoff had 0.85 sensitivity and 0.98 specificity, screening was cost-effective at a peanut allergy prevalence of 36%. The results of this study suggest that the current screening approach to early peanut introduction could be cost-effective at a particular health utility for an in-clinic reaction, SPT sensitivity and specificity, and high baseline peanut allergy prevalence among high-risk infants. However, such conditions are unlikely to be plausible to realistically achieve. Further research is needed to define the health state utility associated with reaction location.

Dog Ownership at Three Months of Age Is Associated With Protection Against Food Allergy

To investigate how environmental factors, specifically pet ownership, during infancy were associated with food allergy.The study consisted of 1303 3-month-old, healthy, exclusively breastfed infants from the general population of England and Wales. The study was done within the Inquiring About Tolerance study, an intervention study assessing the utility of early introduction of common allergens into diet, using the same group of infants.This prospective cohort study was planned as part of the Inquiring About Tolerance Study. Surveys were used at enrollment and monthly to determine environmental exposures in the study population. Family history of atopy, mode of childbirth, day care, antibiotic use, and pet ownership were included in the surveys. Specific immunoglobulin E assay and skin prick test (SPT) for cow’s milk, egg white, cod, peanut, sesame, and wheat were performed at the 3-, 12-, and 36-month visits to evaluate food sensitization in a double-blind placebo-controlled setting. Similarly, SPTs for house dust mites, cat, dog, grass, and tree pollen were performed at 12 and 36 months to evaluate aeroallergen sensitization. Infants were also assessed for atopic dermatitis and skin barrier function. Logistic regression analyses were then applied to assess the exposure variables in a dose-dependent manner (number of pets, access of pets of living spaces).Sixty-eight infants (6.1%, 68 out of 1124) were diagnosed with food allergy during the course of the study. Of those diagnosed, there was an increased association with atopy at the beginning of the study (crude odds ratio [cOR]: 5.74, P < .001), impaired skin barrier (cOR: 5.62, P < .001), and family history of allergy. Cohabitation with dogs was a protective factor against developing food allergy, as evident by a 90% odds reduction (adjusted odds ratio [aOR]: 0.10, P = .02). In fact, a dose-dependent response was seen in which more dogs and more access to living areas was associated with more protection (aOR: 0.11, P = .03). In those living with 2 dogs, there were no study participants who developed allergy. Dog ownership was also associated with decreased food SPT sensitization at 12 months (aOR: 0.17, P < .01) and 36 months (aOR: 0.35, P = .05), decreased aeroallergen sensitization at 36 months (aOR: 0.51, P = .05), and reduction in house dust mite sensitization (aOR: 0.34, P = .02).In the results of the study, it is suggested that cohabitation with dogs may prevent the development of food allergy in infants. The number of dogs present and their degree of access to the home were associated with a dose-dependent response. Additionally, dogs were found to be associated with decreased aeroallergen and house dust mite sensitization.The authors suggest that owning dogs and allowing dogs more access in the household protects against food and environmental allergies. Although efforts were made to adjust for confounding factors, it is difficult to adjust for all possible confounding environmental factors that may be impacting food allergy and atopy development. For example, could dog ownership be associated with increased time outdoors, allowing more sunlight exposure (vitamin D)? Greater understanding of the impacts of modifiable risk factors on allergy will allow improved counseling to families asking questions about whether lifestyle modifications can be beneficial.

A study of skin prick test sensitivity to common allergens in patients of nasobronchial allergy

BACKGROUND: Nasobronchial allergy accounts for a significant burden of allergy all over the world. The prevalence of nasobronchial allergy is increasing, so we conducted an observational study of common allergens by skin prick test (SPT) method in this group of patients.OBJECTIVE: The objective is to study skin sensitivity to various allergens in patients of nasobronchial allergy, using SPT method.MATERIALS AND METHODS: A total of 6000 SPTs were done using 60 allergens on 100 patients of nasobronchial allergy.RESULTS: Males were the predominant group of patients, and nasobronchial allergy was most common in 21–30 years' age group in our study. Among various groups of allergens studied, insects (24%) were the most common offending allergens, followed by dust mite (20%), airborne dust (11.3%), pollens (7.75%), fungi (6%), dander (6%), silk (4%), juicy foods (2.4%), and nonjuicy foods (2.25%). Among insects, moth (30) was the common allergen. Among dust, grain dust (30) was the common allergen. Among pollens, Cassia siamea (20) was most common. Aspergillus fumigatus (16) was the most common fungus to which sensitivity was elicited. Among miscellaneous foods (juicy and nonjuicy), milk, almonds, and cashew nut (4 each) were the common allergens.CONCLUSION: Skin prick testing forms an essential part of a comprehensive approach for allergy remediation. Our study determined skin sensitivity to various allergens for avoidance therapy and immunotherapy in affected patients. Allergy to insects as found in our study to be most common is likely because of prevailing poor sanitation and overcrowded dwellings in the Indian milieu.

The sensitization feature of artemisia allergy and the diagnosis value of skin prick test

Objective:The purpose of this study was to explore the sensitization feature of artemisia allergy and to assess the diagnostic value of skin prick test(SPT) compared with specific IgE(sIgE) test. Method:One hundred and fifty-one patients with typical rhino-conjunctivitis symptoms during pollen season were enrolled and general information was recorded in this study. All subjects received SPT and sIgE test of artemisia allergen. The accuracy rate, sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV), Kappa index and Youden index of SPT for diagnosing artemisia allergy was analyzed. Receiver operating characteristic curve(ROC curve) and the area under the curve was calculated. Result:Among 151 patients, 89(58.9%) was sIgE positive while severe type was 59.6% in positive group. 106(70.2%) was SPT positive while 84.0% was SPT level 3. SPT level was positively associated with sIgE level(r=0.714, P<0.01). While considering SPT level 1 as positive, the sensitivity of SPT diagnosing artemisia allergy was 98.9% and the NPV was 97.8%. While considering SPT level 2 as positive, the accuracy rate of SPT was highest(89.4%) with sensitivity of 97.8%, specificity of 77.4% and NPV of 96.0%. The Kappa index and Youden index was the highest at SPT level 2 compared with other SPT level. The area under the curve was 0.886(95%CI 0.822-0.949, P<0.01). Conclusion:Artemisia allergy tends to be severe type. Strong correlation exists between SPT and sIgE tests of artemisia. SPT level 1 has the highest sensitivity while SPT level 2 has the strongest screening ability of artemisia allergy.

Ischemia-modified albumin levels in children with asthma: a pilot study.

Hypoxia may occur in the severe exacerbations of asthma. Ischemia-modified albumin (IMA) may increase in ischemia, in addition to oxidative stress and inflammation. The aim was to evaluate IMA levels in children during the asthma exacerbation and the asymptomatic period. Children with asthma who were followed up in our clinic were included and healthy children were selected as the control group. The severity of exacerbation was evaluated with Global Initiative for Asthma and Modified Pulmonary Index Score. Serum IMA levels were measured at the time of exacerbation and 4 weeks after treatment during asymptomatic period. Skin prick test and C reactive protein (CRP) levels were measured. A total of 26 patients and 26 controls were included. Mean IMA level was 0.45±0.12 absorbance units -ABSU- during asthma exacerbation and 0.32±0.08 ABSU in the control group (p=0.001). Mean IMA levels (0.41±0.14 ABSU) during the stable period were higher than the control group (p=0.005). There was no difference in terms of IMA levels when patients were grouped according to anti-inflammatory treatment, upper respiratory tract infection before exacerbation, CRP levels or sensitivity of skin prick tests. However, IMA levels were higher in patients with severe asthma exacerbation (p=0.009) in comparison with mild/moderate exacerbation. Positive correlation was observed between IMA levels and severity of exacerbation (r: 0.498, p=0.010). Asthmatic children had higher IMA levels than the control group, both in stable and exacerbated asthma. There was a positive relationship between IMA levels and severity of asthma exacerbation.

Clinical investigation of basophil activation test as a complementary test for house dust mite allergen

Objective:To investigate the clinical application of glass micro fiber basophil activation test (BAT) used as a complementary test for house dust mite allergen.Method:Forty patients with clinical diagnosed allergic rhinitis was test by three methods for house dust mite allergen, skin prick test(SPT),Immuno CAP sIgE, and BAT in vitro. The sensitivity and specificity of glass micro fiber were accessed, and the consistency between BAT, SPT, and Immuno sIgE was analyzed. As in vivo provocation was not performed, gold standard is regarded as the combination of medical history and positive reports of SPT and/or ImmunoCAP sIgE test.Result:Twentythree patients are diagnosed as house dust mite allergic rhinitis by gold standard. The sensitivity and specificity of glass micro fiber BAT were 60.9% and 88.2%, the sensitivity of SPT and sIgE was 87.0% and sIgE 73.9%. The correlation rates between BAT with SPT is 0.67(P<0.05), and sIgE 0.55(P<0.05). The accuracy, predictive value of positive and negative of BAT are 0.47,60.9%,88.2%.The Kappa values of BAT, SPT and sIgE with gold standard are 0.47,0.86,0.71.Conclusion:As a complementary test for house dust mite allergic rhinitis, BAT have a good consistency with SPT and sIgE, while as it has only moderate consistency with "gold standard", further studies are needed to prove its clinical significance.

Component-resolved diagnosis in selecting patients for yellowjacket venom immunotherapy

BackgroundVenom immunotherapy is effective in preventing systemic allergic reactions (SARs), but the diagnosis of venom allergy is problematic. ObjectiveTo compare the performance of component-resolved diagnosis and conventional tests in patients referred for venom immunotherapy. MethodsWe measured serum-specific immunoglobulin E to yellowjacket and honeybee venoms (Ves v 1 and Ves v 5 and Api m 1), cross-reactive carbohydrate determinants, serum basal tryptase (ImmunoCAP, ThermoFisher Scientific, Uppsala, Sweden), and skin prick test reactions in 84 patients referred to receive venom immunotherapy. History of SAR and its severity were evaluated. ResultsOf the 78 patients with suspected yellowjacket venom (YJV) allergy, a history of SAR was confirmed in 47 (60%) and 31 (40%) had a non-SAR reaction. The most accurate tests to confirm venom allergy after a SAR were serum-specific immunoglobulin E to yellowjacket whole-venom extract spiked with Ves v 5 (area under the curve 0.87, 95% confidence interval 0.77–0.97, P < .001) and Ves v 5 (area under the curve 0.86, 95% confidence interval 0.76–0.96, P < .001). Sensitization to Ves v 1 was infrequent and its area under the curve was low (0.62, 95% confidence interval 0.47–0.76, P = .106). Sensitivity of the YJV skin prick test was 86%, but its specificity was low at 54%. Double sensitization to yellowjacket and honeybee occurred frequently in skin prick tests. Of the patients without a SAR, 26% showed a positive reaction to YJV in any serum test and 46% showed a positive reaction in skin tests. ConclusionSpecific immunoglobulin E to the YJV spiked with Ves v 5 confirmed the allergy after a SAR. A history of SAR should be confirmed before testing, because venom sensitization is frequent in other types of reactions.

Eight Aeroallergen Skin Extracts May Be the Optimal Panel for Allergic Rhinitis Patients in Central China

Background: The prevalence of allergic rhinitis (AR) is increasing rapidly in Central China. The skin prick test (SPT) is the standard tool with which to determine the allergen sensitization status in AR patients. Changes in allergen sensitization patterns have been observed within countries and regions due to geographical and seasonal variations. Objective: The aim of this study was to evaluate the profile of SPT reactivity to different aeroallergens in AR patients and to suggest a minimal panel of allergens to detect sensitized patients in Central China. Methods: From January 2015 to December 2016, patients who presented to Tongji Hospital with suspected AR were tested with the same panel of 19 aeroallergens. The results of SPT were analyzed to determine the minimum test battery panel necessary to cover 99% of the cases of SPT sensitization in different age subgroups. Results: A total of 2,416 patients (male:female ratio 1.2:1) were enrolled in our study with an average age of 22.0 years. The overall rate of sensitization to any allergen was 79.0%, and 64.3% of the subjects were monosensitized. The highest sensitized rate was found in the subgroup aged 14-18 years (92.0%), followed by the subgroups of 6-14 years (86.4%), >18 years (75.6%), and ≤6 years (74.9%). The most common sensitization was to Dermatophagoides farinae (71.1%). Testing with 8 allergens (D. pteronyssinus, D. farinae, Platanus, Artemisia, Cryptomeria, Blatella germanica, Humulus, and Alternaria) was sufficient to identify over 99% of the sensitized patients. Conclusion: An SPT panel covering 8 allergen extracts was able to detect almost all sensitized patients suffering from AR symptoms in Central China.

Natural history of immunoglobulin E-mediated cow's milk allergy in a population of Argentine children.

Cow's milk protein allergy is the most common allergy in pediatrics. Immunoglobulin E (IgE)-mediated cow's milk allergy poses a higher risk for life and a worse prognosis. To describe the course of IgE-mediated cow's milk protein allergy and risk factors associated with disease persistence. This was a descriptive, retrospective study conducted in patients seen at the Division of Pediatric Allergy of Hospital Italiano between June 2006 and June 2012 who had been diagnosed with IgE-mediated cow's milk allergy. Out of the 72 patients with IgE-mediated cow's milk allergy, 39 (54%) were boys. Patients' average age at the time of diagnosis was 5.19 ± 3.7months old; the most common symptoms were urticaria and vomiting. Rhinitis and asthma were the most commonly observed concomitant atopic diseases. In the study period, 54.5% of patients developed tolerance at an average age of 32 months old. An 8-mm papule in the skin prick test and casein sensitization were associated with disease persistence. Overall, 54.5% of patients developed tolerance at 32 months old. A significant association was observed between papule size at the time of diagnosis and casein sensitization and disease persistence.

Diagnosis of red meat allergy with antigen-specific IgE tests in serum

Abstract Red meat allergy is a tick-associated hypersensitivity reaction to galactose-α-1,3-galactose (α-gal) and is characterized by anaphylaxis, angioedema, urticaria and/or gastrointestinal symptoms occurring 3–6 hours after ingesting red meat such as beef, pork, or lamb. Diagnosis of red meat allergy is challenging due to the unusually long delay in symptom onset and poor sensitivity of skin prick tests with commercial meat extracts. The primary diagnostic tools available for this disease are quantification of α-gal-, beef-, pork-, and/or lamb-specific IgE in serum, however the diagnostic performance of these tests has not been reported. Using patient data for n=135 patients with red meat allergy and n=37 controls, we found that measurement of α-gal-specific IgE using the bovine thyroglobulin (bTG) ImmunoCAP method had the best overall sensitivity (100%) and specificity (92.3%) for diagnosis of red meat allergy. Measuring α-gal-specific IgE using the streptavidin (SA)-CAP technique or beef- or pork-specific IgE using ImmunoCAP were also effective tests with high sensitivities (89–92%) and variable specificities (65–82%). Lamb-specific IgE and total IgE had essentially no diagnostic value for red meat allergy. Positive and negative predictive values mirrored these trends. Taken together, these findings indicate that the α-gal-specific IgE test by bTG ImmunoCAP is the most useful for establishing a diagnosis of red meat allergy, although α-gal-specific IgE by SA-CAP and beef- and pork-specific IgE by ImmunoCAP are also effective tests.

Prediction of atopy via total immunoglobulin E levels andskin prick tests in patients with psoriasis.

Although the etiopathogeneses of psoriasis and atopy appear to be different, psoriasis has been found to be associated with atopy and atopic dermatitis. In this study, we aimed to determine the role of atopy by examining the medical history and clinical and laboratory findings of patients with psoriasis. Patients with psoriasis, asthma patients, and healthy volunteers were included in the study. Serum total immunoglobulin E (IgE) levels were obtained, and prick tests were administered to all groups. Psoriatic patients demonstrated percentages of atopy history (21.3%) that were higher than those of the healthy subjects (15.7%). The median total IgE level in psoriatic patients was found to be statistically higher than that in the healthy control group (P > 0.05). With respect to mite positivity, there were statistically significant differences in the psoriatic (P < 0.05) and asthmatic groups (P < 0.001) when compared to the healthy control group. Our study is the first to use skin prick tests with psoriatic patients. Skin prick test sensitivity to mites increased in psoriatic patients, and we believe that this finding may be useful in protecting psoriatic patients from activation of psoriasis and in determining the appropriate treatment approach.

Skin Prick Test Analysis in Allergic Rhinitis Patients: A Preliminary Study in Abuja, Nigeria.

Allergic rhinitis (AR) is prevalent in Nigeria, though little information exists on the allergen. We assessed the clinical features of AR patients in our environment based on the allergic rhinitis impact on asthma (ARIA) classification. Only patients with positive skin prick test (SPT) were recruited. Seventy-four patients participated in the study. AR and asthma comorbidity were observed in 13.5%. The proportion of “sneezers-runners” was higher than “blockers” with significantly more “sneezers-runners” having persistent AR (P = 0.007). No relationship was established between these predominant symptoms and the aeroallergens used in this study. Intermittent mild and moderate/severe AR were evident in 13.5% and 31.1%, while persistent mild and moderate/severe were seen in 20.3% and 35.1%, respectively. House dust mites allergen yielded the highest number of positive responses (22.6%) followed by tree pollen (16.8%). No relationship was observed between the allergens tested and AR severity. Majority of patients were oligosensitive (33.8%) and polysensitive (35.1%) and were not significantly associated with AR severity (P = 0.07). Most AR patients presenting for treatment in Abuja, Nigeria, had moderate-severe persistent AR and showed similar SPT sensitization pattern with countries having similar climatic conditions. Sensitization patterns were not related to ARIA classification or predominant AR symptoms.